Key result
Empagliflozin significantly increased Ventilatory Anaerobic Threshold time compared to placebo in patients with T2D and HFrEF (p=0.05).
Why the study?
The cardioprotective benefits of SGLT2 inhibitors are well established, but their effects on cardiopulmonary function measured by CPET in patients with T2D and HFrEF remain largely unknown.
Does empagliflozin improve cardiopulmonary function in patients with T2D and HFrEF?
RCT (n=6)
2:1
Does empagliflozin improve cardiopulmonary function in patients with T2D and HFrEF?
p-value: p=0.05
In a small pilot study of patients with T2D and HFrEF, empagliflozin improved submaximal exercise capacity (VT time) and trended toward improving Ve/VCO2 slope and 6MWT.
May improve submaximal exercise capacity in T2D-HFrEF; hypothesis-generating and requires validation in larger trials.
Background: Cardioprotective benefits of SGLT2 inhibitors (SGLT2i) are well established. However, their effects on cardiopulmonary function measured by CPET in patients with T2D and HFrEF continue to be largely unknown. Objective: Examine the effects of SGLT2i on cardiopulmonary function measured by cardiopulmonary exercise test (CPET) & 6MWT in patients with T2D & HFrEF. Methods: Six subjects with T2D with HFrEF (<40%) (Age=59±2.6, BMI=33.3±1.1, A1c=7.1±0.3, EF 28±4%) were randomized to empagliflozin 25mg (SGLT2i) vs. placebo in a 2:1 fashion for 12 weeks. Cardiac MRI, 6MWT, and CPET were performed pre- and post-intervention. Results: SGLT2i group showed an increase in EF. All subjects reached submaximal cardiovascular effort (RER≤1.10). The Ventilatory Anaerobic Threshold (VT, submaximal index of exercise capacity) showed a significant increase in VT time with SGLT2i (p=0.05). The rest of the parameters trended toward improvement including Ve/VCO2 slope and 6MWT. Conclusion: Subjects with T2D and HFrEF, treated with an SGLT2i had improved EF, a decrease in the worsening of the Ve/VCO2 slope (a predictor of mortality in HF patients), an increase in 6MWT, and significantly improved VT time (aerobic metabolism) compared to placebo. These findings may represent a novel mechanism of CV protection and warrants further investigation. Disclosure Y. Qin: None. C. L. Triplitt: Speaker's Bureau; Novo Nordisk. G. D. Clarke: None. E. Cersosimo: None. S. E. Espinoza: None. R. A. Defronzo: Advisory Panel; AstraZeneca, Bayer Inc., Boehringer-Ingelheim, Novo Nordisk, Research Support; AstraZeneca, Boehringer-Ingelheim, Merck & Co., Inc., Speaker's Bureau; AstraZeneca. C. Solis-herrera: None. F. M. Acosta: None. S. Neppala: None. T. M. Cortes: None. A. Stepanenko: None. A. Moody: None. N. D. Sanchez: None. M. Brown: None. L. A. Cruz moreno: None. Funding Doris Duke Charitable Foundation; Voelcker Foundation; National Institutes of Health
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QIN et al. (2023) conducted an RCT in Type 2 Diabetes and Heart Failure with reduced Ejection Fraction (HFrEF) (n=6). Empagliflozin vs. Placebo was evaluated on Ventilatory Anaerobic Threshold (VT) time (p=0.05). Empagliflozin significantly increased Ventilatory Anaerobic Threshold time compared to placebo in patients with T2D and HFrEF (p=0.05).
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